Welcome to my blog. HIV prevalence is not a reliable indicator of sexual behavior because the virus is also transmitted through unsafe healthcare, unsafe cosmetic practices and various traditional practices. This is why many HIV interventions, most of which concentrate entirely on sexual behavior, have been so unsuccessful.

I don’t claim to be an expert in the field of child protection, and what I have written below is based on a relatively small amount of research and inquiry. I make it available in case it is useful to others doing similar or overlapping work.

I briefly outline a number of alternatives, in no particular order. Some of these activities are already being carried out by NGOs in Tanzania or elsewhere; others are in need of further inquiry; some of them may be practiced but I have not found any details yet (this is just informal research!). The list is by no means exhaustive:

1. Child protection monitoring is lacking in the Tanzanian social welfare system; there are probably too few social welfare officers, with too few skills; more importantly, residential care seems to be one of the few options they consider whenever child protection is involved; many social services are provided by private bodies and there is little that is available nationally
2. Mental health issues in mothers and other family members need to be addressed, especially post natal depression; mental health issues are a common reason cited for children being in institutions, and other research shows that post natal depression is rarely diagnosed, let alone treated
3. Maternal health issues: health problems during pregnancy, delivery and in the months after giving birth are numerous; maternal morbidity and mortality rates are very high in Tanzania; care for the mother must not exclude appropriate care for the child, especially if they are separated; care for the child must involve continued contact with their family
4. Newborn health issues: birth defects, disabilities, developmental problems and doubtless many preventable and/or treatable conditions are common; infant and under 5 mortality very high in Tanzania; where this results in the child being separated from the mother or carer the care must be monitored so that the child is reunited as quickly as possible, and does not lose touch with the family at any time
5. Infant feeding and support for mother/carer/family is an important intervention that has been implemented in various forms in Tanzania for a long time, both large and small scale programs; but this needs to be available to all children, if required; timely programs have prevented a lot of separations of children from their mother/carer, and continue to do so
6. Support and acknowledgement for carers; sometimes the nominated carer has a very low status (social status, legal status, etc) in the family and is not considered to have an integral connection with the child’s welfare; there’s little point in the child bonding with a carer who will soon disappear, to be replaced by another carer, who may have a similarly low status
7. Home support for children with special needs; rare in Tanzania to find any kind of support for children with special needs or their carers; what is available is generally provided by NGOs and other private providers
8. Respite care for carers; such care may be provided by some NGOs but it is rare; informal respite care can be provided by relatives and friends/neighbors but this can carry serious risks, and many carers are completely isolated and without support of any kind
9. Daycare facilities; several NGOs are providing daycare facilities but these are mainly ‘supply driven’, and arise when there is a provider willing to build and run them; being able to send young children to daycare facilities would allow mothers/carers to work without having to worry about leaving their children in riskier circumstances, or leaving them with young siblings, who will then have to miss school
10. Foster care, formal, informal, long and short term; informal foster care is and has been common in Tanzania for a long time, although there is little recognition of the word or concept; there is legislation covering formal foster care but it doesn’t seem to be used much; social welfare tend to be reluctant to try out ‘new’ things
11. Family centered support in the home, eg, financial support, especially where there are indications of poverty, neglect, abuse; families are expected to provide care for children, even children of relatives, also old people, people with special needs, etc; yet many families live in poverty and isolation from healthcare, education and infrastructure; nothing is free when you have no income, so ‘free’ school and healthcare, for example, still involve costs that families struggle to meet, or fail to meet
12. Facilities that care for couples, infant/child and mother/carer, when required; rather than separating infants from mothers or carers in the event of sickness or death, providing facilities that allow them to remain together would significantly increase the child’s chances of thriving and even surviving, and also reduce the risk of separation
13. Specialist facilities for children who can't be at home; special needs often cannot be addressed adequately at home; sometimes a child has so many needs that the family can’t provide that they must spend some time in a specialist facility; but there needs to be better provision for keeping children in touch with their family if they are separated; at present, maintaining contact between children and families is down to the individual provider
14. Support for childless families, those who have experienced loss, stillbirths, etc; fostering and adoption by Tanzania families should be addressed and those who have lost a child, or families who are childless, are often interested in considering caring for a child who has been separated from their family and cannot return
15. Support for facilities reuniting children with families; generally, once a child has been placed in a facility, little effort is made to consider reuniting them with their family; often, families don’t even visit children once they are in a facility; reuniting them with their families can involve a lot of negotiation and logistics that facilities cannot afford, but reuniting them should always be the first concern for facilities and others working with child protection
16. Working with fathers/birthing partners, to encourage women to consider not being alone during delivery and the days after birth; programs that focus on infants, children or women can effectively exclude men, even antagonize them; working with fathers during pregnancy and birth is only one way of including them and could have a significant impact on the tendency to place children in orphanages; working with fathers to understand and negotiate how they can support their partner through pregnancy and delivery and the early months (putting it prosaically, mothers are often afraid of healthcare professionals, but healthcare professionals are often afraid of fathers who turn up to support their partners!)
17. Investigate cases of 'abandonment' and other instances of children being separated; this is a legal/administrative issue that can be very vague when cited as a reason for referring a child to an orphanage; it’s difficult to ‘abandon’ a child without a lot of people knowing about it, so claims of abandonment should be treated with greater caution
18. Investigate cases attributed to 'alcoholism', as some of them may be something entirely different, or something treatable, but that drives the alcoholism; the term ‘alcoholic’ can be applied to anyone who drinks, especially when applied to a woman; some residential facilities are funded by churches that preach against even the slightest association with alcohol
19. Follow up HIV and TB infected children to find out why they are in facilities, where they often cannot benefit from funded programs that are available for those conditions; chronic conditions can prove difficult for families to deal with, but many children are successfully cared for at home, given the right support
20. Investigate cases attributed to 'abuse' to ensure that there is not some other treatable cause that has been categorized as abuse; families are generally reluctant to discuss abuse openly, so it must be questioned when it is used as a reason for admitting a child to an orphanage; of course, abuse does occur, and there are legitimate reasons for children to be separated from their family, and possibly referred to a facility, a foster family, etc
21. Investigate children for whom there is no identifiable reason for their being in a facility, no problem with the child, no problem with the mother/carer/parents/family; if a child is in a facility and no one is visiting them, they can be left without anyone considering their future care; facilities often don’t have the resources to regularly review children’s care plan and social welfare tend to leave such matters to the facility
22. Promotion of Early Childhood Education where this is not available; many children go to school late for various reasons and this can make it difficult for them to catch up; sending children to appropriate education institutions must become the norm; being in daycare or early schooling is preferable to being at home alone, in the care of young siblings or in the care of people who are neither trained nor motivated to look after the child
23. Promotion of inclusive education in public schools; sometimes the smallest reason can be used for delaying a child’s start at school, such as a very minor impairment or disability; for example, there’s no reason for most children with albinism to stay at home; some children out of school have special needs that can be met at state schools, preferably with appropriate measures where the special needs are more acute; waiting until an institution that can provide for special needs is identified, or until the child is older and can more easily access such an institution, leads to long delays
24. There are tools such as the 'Child Development and Monitoring Tool' (from the Suryakanti Foundation), which can help identify, treat and even prevent some conditions that give rise to children having special needs; special needs can include developmental, behavioral, learning, impairments, etc, so it’s important to accurately identify what needs a child has as early as possible

There are many alternatives to ‘orphanages’ and ways of preventing separation of children from their family. But it will be a harder job to assess the needs of every child currently in an institution and reunite them with their family, or care for them more appropriately, than it was to refer them to the institution in the first place. The challenge is to follow Tanzania’s Law of the Child Act to the letter: an orphanage should always be a last resort, and it should not be seen as a permanent solution.

The majority of Tanzanian families are poor, a lot are living below the poverty line, unemployed, unskilled and isolated from services they need to change things for themselves. Orphanages and NGOs, donors and sponsors have long been seen as a lifeline, a way of getting one or more children cared for and educated, perhaps so that they can do more for their family later. If resources and funding are to be reduced in one area of child protection, they must be redeployed elsewhere.

But the proliferation of orphanages in a region such as Arusha has merely led to the expectation that more and more orphanage places will be provided. And children will continue to be referred to orphanages as long as a justification that is acceptable to social welfare can be found. Support, funding and sponsorship need be redeployed in ways that avoid separating families.

This is a working document and it will continue to be developed if people make contributions, comments, criticisms, etc. Thank you in advance!